Question: "I've had two ballon angioplasties to open blocked heart arteries, one including a stent. But both times scar tissue caused the artery to re-close, and I needed to have them re-opened. Now I have another blockage. Is it time to think of open-heart surgery, or do I have other options?"

Mitchell Driesman, MD, left, chief of Interventional Cardiology at Bridgeport Hospital, and Joel Kupfer, MD, right, were the first cardiologists in Fairfield County to use a new type of stent to hold heart arteries open.

Mitchell Driesman, MD and Joel Kupfer, MD respond:

Dr. Driesman: We're glad to say that there is now another option for people like you, whose arteries tend to re-close even when stents are used to hold the arteries open. It's a new type of stent, approved in April 2003 by the Food and Drug Administration (FDA), and it's called a drug-eluting stent. (Eluting means continuously releasing small amounts of medication.)

Dr. Kupfer: First, a little background. Angioplasty involves inserting a balloon-tipped catheter through a groin artery and passing it along the blood vessels up to the blocked heart artery. There, inflating the balloon pushes aside the blockage. Then inserting a stent can help hold the artery open. A stent is a cylinder-shaped wire mesh scaffold that fits within the artery to brace the artery walls and reduce the chances of re-closure.

Dr. Driesman: With regular stents, however, the growth of scar tissue around the stent sometimes re-closes the artery within a few months. In fact, regular stents have some degree of re-closure in 30-40% of patients at the 6-month mark after angioplasty (with a repeat procedure being required in half of these patients).

This new drug-eluting stent, however, is coated wth a medicine that reduces re-closing of arteries more effectively than the traditional stents.

Dr. Kupfer: The new stents are coated with sirolimus, a naturall occuring antibiotic. Continuously released at the site of the blockage, this medication prevents the excess cell growth and scarring that can cause re-closure.

Dr. Driesman: Several recent studies helped to prove to the FDA that the new stent would be very effctive, and merited approval. One study invloved 238 patients, half of whom received stents coated with sirolimus. The other half (called the control group) received regular, non-medicated stents. The results were impressive: In the sirolimus group, there was zero re-closure of the arteries, while the control group had 26% re-closure after 210 days.

Dr. Kupfer: In a larger study, there was a 91% reduction in re-closures in the group receiving the medicated stent.

Dr. Driesman: Interventional cardiologists at Bridgeport Hospital are proud to have been the first in Fairfield County to use these new drug-eluting stents. In fact, the very first day the approved stents arrived, Dr. Kupfer and I both placed them in patients.

Dr. Kupfer: Coronary artery bypass graft (CABG), or open-heart surgery, remains an important method of treating blocked arteries. CABG is the gold standard when several arteries are blocked, or when the artery is blocked so completely that a balloon catheter cannot be inflated within the blockage, or when the blocked artery is in a location that is hard to reach for angioplasty.

Dr. Driesman: For many people, though, the cardiovascular specialists at Bridgeport Hospital believe these improved stents represent a major breakthrough in the treatment of coronary artery disease.For an article with more information about drug-eluting stents,
call 384-4444.

Seeking an Expert Heart Hospital?

When it comes to choosing your hospital for heart services, it's good to know that the Heart Institute at Bridgeport Hospital is ranked #1 in Connecticut for Cardiac Interventions (angioplasty and similar non-invasive artery-clearing procedures) and in the Top 10% in the nation for Cardiology Services. This ranking was granted by HealthGrades, a national organization that rates hospital services based on medical and surgical data. HealthGrades also gave Bridgeport Hospital its highest rating (five stars) for treatment of heart attacks.

To make sure the cardiologist or cardiothoracic surgeon you select is affiliated with Fairfield County's most preferred hospital, call Bridgeport Hospital Physician Referral, 24/7, English/Spanish, at 888-357-2396.